Predicting risk for preventable patient healthcare events

ABSTRACT

Evaluating future healthcare event risks of a patient includes receiving, at one or more computers, patient healthcare data for the patient, wherein the patient healthcare data represents a healthcare event and includes one or more healthcare codes, accessing, with the one or more computers, a database that associates the healthcare event and the healthcare codes with risks of potentially preventable healthcare events, and presenting, with the one or more computers, indications of the risks of potentially preventable healthcare events to a user to facilitate mitigation of the risks of potentially preventable healthcare events for the patient.

TECHNICAL FIELD

This disclosure relates to analysis of medical data in the medicalindustry and more specifically analysis of patient medical data.

BACKGROUND

In the healthcare field, patient readmissions are a source of waste andcontribute to increased overall costs for the system, which translate tohigher payment costs for insurers and higher healthcare coverage ofindividuals. In addition, some major payers such as Medicare have begunto impose substantial payment penalties to hospitals that have highreadmission rates. As a result, hospitals are making major investment inprocesses and programs to reduce patient readmission. In order to bemost effective, efforts to reduce readmissions should begin and occurduring a patient's stay in the hospital.

SUMMARY

In general, this disclosure relates to predicting risk for preventablepatient healthcare events, such as patient readmission, on apatient-by-patient basis. In different examples, predicting risk forpreventable patient healthcare events may be based on: a patient'sreason for hospitalization, acuity, demographic characteristics, burdenof chronic illness, health status, socioeconomic status, pharmaceuticalusage, and/or detailed clinical data such as history and laboratory testresults. The probability of the occurrence of specific types ofpotentially preventable readmissions may be used to allocate medicalprovider, such as hospital, resources during a patient's hospital stayin order to prevent post discharge readmissions. In addition, theprobability of the occurrence of specific types of potentiallypreventable readmissions may be used to compare the performance ofindividual providers, including physicians, in terms of their rate ofpotentially preventable readmissions.

In one example, this disclosure is directed to a method of evaluatingfuture healthcare event risks of a patient, via one or more computers.The method comprises receiving, at the one or more computers, patienthealthcare data for the patient, wherein the patient healthcare datarepresents a healthcare event and includes one or more healthcare codes,accessing, with the one or more computers, a database that associatesthe healthcare event and the healthcare codes with risks of potentiallypreventable healthcare events, presenting, with the one or morecomputers, indications of the risks of potentially preventablehealthcare events to a user to facilitate mitigation of the risks ofpotentially preventable healthcare events for the patient.

In another example, this disclosure is directed to a computer-readablestorage medium that stores computer-executable instructions that, whenexecuted, configure a processor to access patient healthcare data for apatient, wherein the patient healthcare data represents a healthcareevent and includes one or more healthcare codes, access a database thatassociates the healthcare event and the healthcare codes with risks ofpotentially preventable healthcare events, and present indications ofthe risks of potentially preventable healthcare events to a user tofacilitate mitigation of the risks of potentially preventable healthcareevents for the patient.

In a further example, this disclosure is directed to a computer systemcomprising one or more databases storing patient healthcare data for apatient and associations between healthcare codes and risks ofpotentially preventable healthcare events, and one or more processors.The one or more processors being configured to access the patienthealthcare data for the patient, wherein the patient healthcare datarepresents a healthcare event and includes one or more healthcare codes,access associations between the healthcare event and the healthcarecodes with risks of potentially preventable healthcare events, andpresent indications of the risks of potentially preventable healthcareevents to a user to facilitate mitigation of the risks of potentiallypreventable healthcare events for the patient.

In an example, this disclosure is directed to a method of evaluatingfuture readmission risks of a patient, via one or more computers, themethod comprising receiving, at the one or more computers, patienthealthcare data for the patient, wherein the patient healthcare datarepresents a healthcare event associated with a hospital admission andincludes one or more healthcare codes, accessing, with the one or morecomputers, a database that associates the healthcare codes with risks ofpotentially preventable readmission events, and presenting, with the oneor more computers, indications of the risks of potentially preventablereadmission events to a user to facilitate mitigation of the risks ofpotentially preventable readmission events for the patient.

In another example, this disclosure is directed to a method ofevaluating future healthcare event risks of a patient, via one or morecomputers. The method comprises accessing, with the one or morecomputers, indications of risks of potentially preventable healthcareevents associated with the patient, accessing, with the one or morecomputers, personal health information associated with the patient,adjusting, with the one or more computers, the risks of potentiallypreventable healthcare events associated with the patient based on thepersonal health information associated with the patient, produceadjusted risks of potentially preventable healthcare events, andpresenting, with the one or more computers, indications of the adjustedrisks of potentially preventable healthcare events to a user tofacilitate mitigation of the risks of potentially preventable healthcareevents for the patient.

In a further example, this disclosure is directed to a computer-readablestorage medium that stores computer-executable instructions that, whenexecuted, configure a processor to access indications of risks ofpotentially preventable healthcare events associated with the patient,access personal health information associated with the patient, adjustthe risks of potentially preventable healthcare events associated withthe patient based on the personal health information associated with thepatient, produce adjusted risks of potentially preventable healthcareevents, and present indications of the adjusted risks of potentiallypreventable healthcare events to a user to facilitate mitigation of therisks of potentially preventable healthcare events for the patient.

In another example, this disclosure is directed to a computer systemcomprising one or more databases storing indications of risks ofpotentially preventable healthcare events associated with the patientand personal health information associated with the patient, and one ormore processors. The one or more processors being configured to accessthe indications of risks of potentially preventable healthcare eventsassociated with the patient, accessing the personal health informationassociated with the patient, adjust the risks of potentially preventablehealthcare events associated with the patient based on the personalhealth information associated with the patient, produce adjusted risksof potentially preventable healthcare events, and present indications ofthe adjusted risks of potentially preventable healthcare events to auser to facilitate mitigation of the risks of potentially preventablehealthcare events for the patient.

The details of one or more examples of this disclosure are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of this disclosure will be apparent from thedescription and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a block diagram illustrating an example of a standalonecomputer system for determining risks of potentially preventablehealthcare events.

FIG. 2 is a block diagram illustrating an example of a distributedcomputer system for determining risks of potentially preventablehealthcare events.

FIG. 3 is a flowchart illustrating an example technique for evaluatingfuture healthcare event risks of a patient to facilitate mitigation ofthe risks of potentially preventable healthcare events for the patient.

FIG. 4 is a flowchart illustrating an example technique for evaluatingfuture healthcare event risks of a patient based on personal healthinformation associated with the patient to facilitate mitigation of therisks of potentially preventable healthcare events for the patient.

FIG. 5 is a flowchart illustrating an example technique for evaluatingfuture healthcare event risks of a patient based on personal informationassociated with the patient to facilitate mitigation of the risks ofpotentially preventable healthcare events for the patient.

DETAILED DESCRIPTION

This disclosure describes systems and techniques for determining risksof potentially preventable healthcare events. The systems and techniquesmay be used by a healthcare provider, such as a hospital or healthmaintenance organization, to efficiently allocate resources to mitigaterisks of identified potentially preventable healthcare events on apatient-by-patient basis. For example, healthcare providers may receiveindications of the risks of specific potentially preventable healthcareevents for admitted patients in time to mitigate the identified risks.Generally, such patient-by-patient risk analysis is completed anddisseminated prior to the discharge of a patient from a medical facilityas it usually most effective to mitigate identified risks before thepatient is discharged from the medical facility. In other examples,patient-by-patient risk analysis may be completed at discharge orimmediately following discharge and still allow mitigation of risks ofthe identified potentially preventable healthcare events associated withparticular patients.

Although the techniques disclosed herein are generally directed topredicting potentially preventable readmissions, the techniques areequally applicable to preventing other potentially preventablehealthcare events. As referred to herein, healthcare events includeinpatient admissions, emergency room visits, and outpatient ancillaryservices.

While the described techniques may clearly be used to improve patientcare, there are also financial incentives for healthcare providers toreduce preventable patient readmissions. For example, some major payerssuch as Medicare have begun to impose substantial payment penalties tomedical providers, such as hospitals, that have high readmission rates.Interventions to reduce patient readmissions are labor intensive andmedical providers have limited staff to devote to readmission reductionefforts. The disclosed techniques facilitate efficient targetingreadmission prevention efforts on those patients who are most likely tobe readmitted, and for whom the readmission prevention efforts are mostlikely to be successful.

As one example, the disclosed techniques allow medical providers topredict at any point during an inpatient stay the likelihood(probability) that the patient will have a potentially preventablereadmission. Research suggests that roughly forty percent of patientreadmissions are not preventable. For example, a readmission due to aninjury from a traffic accident or appendicitis would not be preventableif that patient's prior admission was factually unrelated to the trafficaccident or appendicitis.

The techniques disclosed herein focus on predicting risk of readmissionsthat are potentially preventable because these are the only readmissionsfor which an intervention can be successful. Once the probability (orrisk) of a preventable readmission is known for an individual patient,medical providers, such as hospitals, can use the probability toprioritize the deployment of their limited readmission interventionresources to those patients with the highest risk of having apotentially preventable readmission. The probability of potentiallypreventable readmissions can also be used to compute the expected numberof potentially preventable readmissions for individual providersincluding physicians. The expected number of potentially preventablereadmissions for a provider can then be compared to the actual number ofpotentially preventable readmissions that occurred for that provider. Bycomparing the actual and expected number of potentially preventablereadmissions, education, interventions and payment penalties can betargeted to providers with poor potentially preventable readmissionperformance.

In addition to predicting the risk of potentially preventable healthcareevents in the future for individual patients, the presently describedsystem and techniques may also classify current or past individualhealthcare events as either potentially preventable or not-potentiallypreventable. Potentially preventable healthcare events are those eventsthat may represent excessive healthcare services, i.e. waste. Healthcareproviders may wish to determine and track their rate of potentiallypreventable healthcare events in order to implement internal proceduresto reduce the rate.

As described in greater detail below, the methods of this disclosure maybe performed by one or more computers. As examples, the methods may beperformed by a standalone computer, or may be executed in aclient-server environment in which a user views the determined risks ofpotentially preventable healthcare events at a client computer. In thelatter case, the client computer may communicate with a server computer.The server computer may store the patient healthcare data and apply thetechniques of this disclosure to determine risks of potentiallypreventable healthcare events and output the results to the clientcomputer. In addition to these two examples, the methods may beperformed in other computer environments.

In one example, a method includes receiving, at the one or morecomputers, patient healthcare data, wherein the patient healthcare datarepresents a healthcare event and includes one or more healthcare codes.The method may further include determining, by the one or more computersand based on the one or more healthcare codes, one or more patientfactors associated with the healthcare event. After determining the oneor more patient factors, the method may determine, by the one or morecomputers and based on the one or more healthcare codes and the one ormore patient factors associated with the healthcare event, risks ofpotentially preventable healthcare events. In some examples, thehealthcare event may comprise one of an inpatient admission, anemergency room visit, and an outpatient ancillary service.

Throughout the description of the techniques and systems of the presentdisclosure, the description exemplifies the techniques and systems asdetermining risks of potentially preventable healthcare events. In thecontext of this description, the term potentially preventable healthcareevent implies a healthcare event is associated with one or morehealthcare codes and/or determined patient factors that are consistentwith a potentially preventable event. In other words, the techniques andsystems described herein focus only on determining risk of potentiallypreventable healthcare events, and not on the overall risks ofhealthcare events. In some particular examples, the techniques andsystems described herein focus may be specifically directed todetermining risks of potentially preventable readmissions. In furthermore specific examples, such techniques may be applied to determiningrisks of potentially preventable hospital readmissions only or risks ofpotentially preventable hospital readmissions, emergency room (ER) staysand outpatient observation stays.

FIG. 1 is a block diagram illustrating an example of a stand-alonecomputerized system for determining risks of potentially preventablehealthcare events consistent with this disclosure. The system comprisescomputer 110 that includes a processor 112, a memory 114, and an outputdevice 116, such as a display screen. Computer 110 may also include manyother components, and the functions of any of the illustrated componentsincluding computer 110, processor 112, a memory 114, and output device216, may be distributed across multiple components and separatecomputing devices, e.g., as illustrated with respect to the distributedcomputing system of FIG. 2. The illustrated components are shown merelyto explain various aspects of this disclosure.

Memory 114 includes patient healthcare data 130, which may comprise datacollected in documents such as patient healthcare records, among otherinformation. Memory 114 further includes risk database 136. Riskdatabase 136 associates healthcare events and healthcare codes withrisks of potentially preventable healthcare events. In some examples,risk database 136 includes a matrix or list that identifies potentiallypreventable healthcare events for each of a plurality of healthcarecodes. Memory 114 may further include patient factors 132 and processedevents 134. Processor 112 is configured to include a user interfacemodule 122 and a preventable event module 120 that executes techniquesof this disclosure with respect to patient healthcare data 130 and, insome cases, patient factors 132. In some examples, processed events 134may comprise information such as which healthcare events processor 112and/or preventable event module 120 determines to be potentiallypreventable healthcare events associated with a current healthcare eventor code of a patient. Also in some examples, patient factors 132 maystore various associations, as described below, between one or morehealthcare codes.

Processor 112 may comprise a general-purpose microprocessor, a speciallydesigned processor, an application specific integrated circuit (ASIC), afield programmable gate array (FPGA), a collection of discrete logic, orany type of processing device capable of executing the techniquesdescribed herein. In one example, memory 114 may store programinstructions (e.g., software instructions) that are executed byprocessor 112 to carry out the techniques described herein. In otherexamples, the techniques may be executed by specifically programmedcircuitry of processor 112. In these or other ways, processor 112 may beconfigured to execute the techniques described herein.

Memory 114 may represent any volatile or non-volatile storage elements.Examples include random access memory (RAM) such as synchronous dynamicrandom access memory (SDRAM), read-only memory (ROM), non-volatilerandom access memory (NVRAM), electrically erasable programmableread-only memory (EEPROM), and FLASH memory. Examples may also includenon-volatile storage, such as a hard-disk, magnetic tape, a magnetic oroptical data storage media, a compact disk (CD), a digital versatiledisk (DVD), a Blu-ray disk, and a holographic data storage media.

Output device 116 may comprise a display screen, although thisdisclosure is not necessarily limited in this respect, and may alsoinclude other types of output capabilities. In some cases, output device116 may generally represent both a display screen and a printer in somecases. Preventable event module 120, and in some cases in conjunctionwith user interface module 122, may be configured to cause output device116 to output patient healthcare data 130, patient factors 132,processed events 134, or other data. In some instances, output device116 may include a user interface (UI) 118. UI 118 may comprise an easilyreadable interface for displaying the output information.

In one example, preventable event module 120 receives patient healthcaredata 130. Generally, patient healthcare data 130 may include informationincluded in a patient healthcare record or any other documents or filesdescribing patient healthcare events. For example, when a patient has anencounter with a healthcare facility, such as during an inpatientadmission, an emergency room visit, or an outpatient visit, all of theinformation gathered during the encounter and preceding the encountermay be consolidated into a patient healthcare record describing theparticular healthcare event. In one example, such a patient healthcarerecord may include any procedures performed, any medications prescribed,any notes written by a physician or nurse, and generally any otherinformation concerning the healthcare event. Additionally, theinformation may include the location of residence of the patient. Forexample, the location of residence may indicate whether the patientcurrently resides in a private home or in a managed home, such as anursing home or other permanent or semi-permanent medical facility.

Patient healthcare data 130 may further include information fromhealthcare claims forms. These claims forms, or other documents in thepatient medical record, may include one or more standard healthcarecodes, as described in more detail below. The documents referred toherein are not limited to paper documents physically placed in a folderor other record keeping device. Increasingly, medical records are storedelectronically. Accordingly, patient healthcare data 130 may be paperrecords fed into computer 110, or computer 110 may receive patienthealthcare data electronically. Additionally, each piece of informationincluded in patient data 130 may further be associated with a particulardate. For example, patient healthcare data 130 may include multiplepieces of information associated with an inpatient admission eventoccurring on Mar. 20, 2005. In such an example, each piece ofinformation related to that inpatient admission event may further beassociated with the date Mar. 20, 2005 (or other relevant date if allthe services or procedures relating to the inpatient admission did notoccur on that exact date). In total, patient healthcare data 130 maycomprise a complete or partial medical history. For example, all of thehealthcare events for a given patient may be placed in order by date,thereby giving an overview of the chronological healthcare events thathave occurred for a given patient.

Patient healthcare data 130 may further include one or more standardhealthcare codes. In some examples, the patient healthcare records orthe healthcare claims forms may include one or more of these standardhealthcare codes, which generally may describe the services andprocedures delivered to a patient. Examples of such healthcare codesinclude codes associated with the International Classification ofDiseases (ICD) codes, Current Procedural Technology (CPT) codes,Healthcare Common Procedural Coding System codes (HCPCS), and NationalDrug Codes (NDCs). Each of these standard healthcare codes undergoesmodification every few years, and the techniques and system of thepresent description contemplate using any such version of each of theabove-described codes. Other standard healthcare codes that may beincluded in patient healthcare data 118 may include Diagnostic RelatedGroup (DRG) codes, and Enhanced Ambulatory Patient Group (EAPG) codes.In some examples, these DRG and EAPG codes may be determined from theother standard healthcare codes. Additionally, these DRG and EAPG codesmay represent a specific category of disease or health problem thepatient suffers from or has suffered from in the past.

In some particular examples, patient healthcare data 130 may includeproprietary codes, such as All Patient Refined™ Diagnosis Related Groups(APR™ DRGs), available from 3M Company of Saint Paul, Minn. APR™ DRGsexpand the basic DRG structure by adding two sets of subclasses to eachbase APR™ DRG. Each subclass set consists of four subclasses: oneaddresses patient differences relating to severity of illness and theother addresses differences in risk of mortality. Severity of illness isdefined as the extent of physiologic decompensation or organ system lossof function. Risk of mortality is defined as the likelihood of dying.The additional data from APR™ DRGs as compared to the basic DRGstructure may facilitate more accurate evaluations of the risks offuture preventable patient healthcare events for a patient.

Different codes may be used with outpatient ancillary services ascompared to inpatient services. Outpatient ancillary services representauxiliary or supplemental services, such as diagnostic services, homehealth services, physical therapy and occupational therapy, used tosupport diagnosis and treatment of a patient's condition. In differentexamples, outpatient ancillary services may be characterized accordingto ambulatory patient group (APG) codes and/or according to enhancedambulatory patient group (EAPG) codes, available from 3M Company ofSaint Paul, Minn. APGs and EAPGs are to outpatient procedures what DRGsare to inpatient days; for example, EAPGs provide for a fixedreimbursement to an institution for outpatient procedures or visits andincorporate data regarding the reason for the visit and patient data.

Preventable event module 120 may further determine one or more patientfactors based on patient healthcare data 130. Some examples of patientfactors include a location of residence, the type of healthcare event,the sequence of events, and the clinical necessity for service.

In some examples, preventable event module 120 may determine the stageand severity of any diseases or other health problems based on patienthealthcare data 130. For example, preventable event module 120 may usethe one or more associated healthcare codes to determine the existenceand severity of any disease or other health problem from which thepatient suffers at the time of a healthcare event. These diseases andhealth problems may generally be referred to as comorbid diseases. Forexample, preventable event module 120 may determine comorbid diseasesand severity based on one or more received healthcare codes associatedwith dates prior to the current event. In other words, preventable eventmodule 120 may receive historical patient medical data, and from thatdata determine the stage and extent of any comorbid diseases. In someexamples, the healthcare codes directly indicate the existence of anydisease or other health problem and the severity level. In otherexamples, patient healthcare data 130 determines the existence of anydisease or other health problem and severity level based on thetreatment directly indicated by the one or more healthcare codes.

In some examples, as described previously, patient healthcare data 130may include standard healthcare codes, such as ICD codes, CPT codes,HCPCS codes, and the like. At least some of these particular healthcarecodes may be associated with future potentially preventable healthcareevents or medical encounters. Accordingly, preventable event module 120may use this historical data to produce a snapshot of the stage andextent of any comorbid disease a patient suffers from. As one example,preventable event module 120 may process the healthcare data todetermine the existence and severity of any comorbid diseases inaccordance with the techniques disclosed in U.S. Pat. No. 7,127,407 toAverill et al., the entire contents of which are incorporated byreference. For example, preventable event module 120 may categorizeinformation included in patient healthcare data 130 into a multi-levelcategorical hierarchy.

As discussed in further detail below, preventable event module 120 mayaccess patient healthcare data 130 and risk database 136, as well as,patient factors 132 and/or processed events 134 to evaluate futurehealthcare event risks of a patient. Preventable event module 120 mayfurther present indications of the risks of potentially preventablehealthcare events to a user via output device 116 to facilitatemitigation of the risks of potentially preventable healthcare events forthe patient. For example, preventable event module 120 may furtherpresent indications of the risks of potentially preventable healthcareevents to a user via a display of output device 116.

The system of FIG. 1 is a stand-alone system in which processor 112 thatexecuted preventable event module 120 and output device 116 that outputsvarious data reside on the same computer 110. However, the techniques ofthis disclosure may also be performed in a distributed system thatincludes a server computer and a client computer. In this case, theclient computer may communicate with the server computer via a network.The preventable event module may reside on the server computer, but theoutput device may reside on the client computer. In this case, when thepreventable event module causes display prompts, the preventable eventmodule causes the output device of the client computer to display thedata, e.g., via commands or instructions communicated based on theserver computer to the client computer.

FIG. 2 is a block diagram of a distributed system that includes a servercomputer 210 and a client computer 250 that communicate via a network240. In the example of FIG. 2, network 240 may comprise a proprietary onnon-proprietary network for packet-based communication. In one example,network 240 comprises the Internet, in which case communicationinterfaces 226 and 252 may comprise interfaces for communicating dataaccording to transmission control protocol/internet protocol (TCP/IP),user datagram protocol (UDP), or the like. More generally, however,network 240 may comprise any type of communication network, and maysupport wired communication, wireless communication, fiber opticcommunication, satellite communication, or any type of techniques fortransferring data between a source (e.g., server computer 210) and adestination (e.g., client computer 250).

Server computer 210 may perform the techniques of this disclosure, butthe user may interact with the system via client computer 250. Servercomputer 210 may include a processor 212, a memory 214, and acommunication interface 226. Client computer 250 may include acommunication interface 252, a processor 242 and an output device 216.Output device 216 may comprise a display screen, although thisdisclosure is not necessarily limited in this respect and other outputdevices may also be used. Of course, client computer 250 and servercomputer 210 may include many other components and the functions of anyof the illustrated components, including server computer 210, processor212, a memory 214, network 240, client computer 250, processor 242 andoutput device 216, may be distributed across multiple components andseparate computing devices. The illustrated components are shown merelyto explain various aspects of this disclosure.

Memory 214 stores patient healthcare data 230, which may comprise datacollected in documents such as patient healthcare records, among otherinformation. Memory 214 further includes risk database 236. Riskdatabase 236 associates healthcare events and healthcare codes withrisks of potentially preventable healthcare events. In some examples,risk database 236 includes a matrix or list that identifies potentiallypreventable healthcare events for each of a plurality of healthcarecodes. Memory 214 may further stores patient factors 232 and/orprocessed events 234. Processor 212 of server computer 210 is configuredto include preventable event module 220 that executes techniques of thisdisclosure with respect to patient healthcare data 230. Memory 214 mayrepresent any volatile or non-volatile storage elements. Examplesinclude random access memory (RAM) such as synchronous dynamic randomaccess memory (SDRAM), read-only memory (ROM), non-volatile randomaccess memory (NVRAM), electrically erasable programmable read-onlymemory (EEPROM), and FLASH memory. Examples may also includenon-volatile storage, such as a hard-disk, magnetic tape, a magnetic oroptical data storage media, a compact disk (CD), a digital versatiledisk (DVD), a Blu-ray disk, and a holographic data storage media.

Processors 212 and 242 may each comprise a general-purposemicroprocessor, a specially designed processor, an application specificintegrated circuit (ASIC), a field programmable gate array (FPGA), acollection of discrete logic, or any type of processing device capableof executing the techniques described herein. In one example, memory 214may store program instructions (e.g., software instructions) that areexecuted by processor 212 to carry out the techniques described herein.In other examples, the techniques may be executed by specificallyprogrammed circuitry of processor 212. In these or other ways, processor212 may be configured to execute the techniques described herein.

Output device 216 on client computer 250 may comprise a display screen,and may also include other types of output capabilities. For example,output device 216 may generally represent both a display screen and aprinter in some cases. Preventable event module 220 may be configured tocause output device 216 of client computer 250 to output patienthealthcare data 230 or processed events 234. User interface (UI) 218 maybe generated, e.g., as output on a display screen, so as to allow a userenter various selection parameters or other information.

Similar to the standalone computer example of FIG. 1, in the distributedcomputing system example of FIG. 2, preventable event module 220 maydetermine risks of potentially preventable healthcare events based onpatient healthcare data 230 and patient factors 232. Additionally, theother components of FIG. 2 with names similar to components depicted inFIG. 1 may perform similar functions as the components of FIG. 1 asdescribed previously.

In some examples, preventable event module 220 may receive selectioninput from client computer 250. For example, preventable event module220 may be configured to receive user input in order to determine thepotentially preventable healthcare events. For example, a user may enterselection parameters at user interface (UI) 218. Again, communicationinterfaces 226 and 252 allow for communication between server computer210 and client computer 250 via network 240. In this way, preventableevent module 220 may execute on server computer 210, but may receiveinput from client computer 250. A user operating on client computer 250may log-on or otherwise access preventable event module 220 of servercomputer 210, such as via a web-interface operating on the Internet or apropriety network, the Cloud, or via a direct or dial-up connectionbetween client computer 250 and server computer 210. In some cases, datadisplayed on output device 230 may be arranged in web pages served fromserver computer 210 to client computer 250 via hypertext transferprotocol (HTTP), extended markup language (XML), or the like.

In at least one example, the user input may comprise parameters by whichpreventable event module 220 determines risks of potentially preventablehealthcare events. A user may specify only certain patients for which todetermine risks of potentially preventable healthcare events. In someexamples, preventable event module 220 may be further configured toperform functions similar to preventable event module 120 as describedin FIG. 1.

In at least one example, preventable event module 220 receives patienthealthcare data 230. As described previously, patient healthcare data230 may include information included in a patient healthcare record orany other documents or files describing a patient encounter with ahealthcare facility, including medical claims forms. Patient healthcaredata 230 may further include one or more standard healthcare codes, suchas (ICD) codes (versions 9 and 10), Current Procedural Technology (CPT)codes, Healthcare Common Procedural Coding System codes (HCPCS), andPhysician Quality Reporting System (PQRS) codes as described previously.Patient healthcare data 230 may also include other standard healthcarecodes such as Diagnostic Related Group (DRG) codes and National DrugCodes (NDCs). These DRG codes may represent a specific category ofdisease or health problem the patient suffers from or has suffered fromin the past if the DRG is associated with a past event.

Preventable event module 220 may then determine risks of potentiallypreventable healthcare events for individual patients. For example,preventable event module 220 may determine one or more healthcare eventsassociated with one or more of the received healthcare codes.Preventable event module 220 may further determine one or more patientfactors associated with the determined healthcare events. Preventableevent module 220 may store these patient factors in memory 214 and/orpatient factors 232.

According to techniques of the present disclosure, preventable eventmodule 220 may then determine risks of potentially preventablehealthcare events based on the one or more healthcare codes and the oneor more determined patient factors and the associations betweenhealthcare events and risks of potentially preventable healthcare eventswithin risk database 236. Preventable event module 220 may determinethese risks of potentially preventable healthcare events in accordancewith the method described previously with respect to preventable eventmodule 120.

Preventable event module 220 may then send, in some examples, inconjunction with user interface module 222, to communication interface226, through network 240, to communication interface 252, to processor242, and finally to output device 216. In this way, a user may view theresults of the determination of potentially preventable healthcareevents, and the risks of potentially preventable healthcare events maybe mitigated.

FIG. 3 is a flowchart illustrating an example technique for evaluatingfuture healthcare event risks of a patient to facilitate mitigation ofthe risks of potentially preventable healthcare events for the patient.For clarity, the techniques of FIG. 3 are described with respect tocomputer 110 of FIG. 1, although the techniques are equally applicableto a distributed computing system, including the example distributedcomputing system illustrated in FIG. 2.

Computer 110 receives patient healthcare data 130 for a patient (302).For example, computer 110 may receive patient healthcare data 130 from apatient from a remote database or computer 110 may maintain updatedpatient healthcare data 130 within memory 114. The patient healthcaredata 130 represents a healthcare event and includes one or morehealthcare codes. Computer 110 accesses risk database 136 (304). Riskdatabase 136 associates a current healthcare event and the healthcarecodes with risks of potentially preventable healthcare events. In someexamples, risk database 136 includes a matrix or list that identifiespotentially preventable healthcare events for each of a plurality ofhealthcare codes.

Computer 110 then presents indications of the risks of potentiallypreventable healthcare events to a user to facilitate mitigation of therisks of potentially preventable healthcare events for the patient viaoutput device 116 (306). For example, computer 110 may present therelative probabilities of each of the potentially preventable healthcareevents for the patient to the user. In some examples, presentingindications of the risks of potentially preventable healthcare events tothe user includes selecting potentially preventable healthcare eventswith relatively higher risks among a plurality of potentiallypreventable healthcare events associated with the healthcare event andthe healthcare codes in the database. In this manner, only thepotentially preventable healthcare events with most severe risks may bedisplayed for a user, which may highlight these risks and improve theability of the user to implement effective risk mitigation measures.

In the same or different examples, as described in further detail withrespect to FIG. 4, computer 110 may adjust the risks of potentiallypreventable healthcare events stored in risk database 136 based onpersonal health information associated with the patient, to produceadjusted risks of potentially preventable healthcare events. In thismanner, the baseline risks of potentially preventable healthcare eventsstored within risk database may be adjusted to more accuratelycharacterize the risks of potentially preventable healthcare events foran individual patient based on personal health information associatedwith the patient. In such examples, presenting the indications of therisks of potentially preventable healthcare events to the user mayinclude presenting indications of the adjusted risks of potentiallypreventable healthcare events to the user.

In some examples, computer 110 may create or update associations betweenhealthcare events and healthcare codes within risk database 136. As oneexample, computer 110 may access a database of healthcare data for aplurality of patients in order to find correlations between healthcareevents within the healthcare data. Computer 110 may further determinethe probability of potentially preventable healthcare events for eachhealthcare code within the database. In one particular example, computer110 may create or update associations between healthcare events andhealthcare codes within risk database 136 using administrative claimsdata. Administrative claims data may include DRG codes, or APR™-DRGcodes for a large group of patients.

In addition, with respect to a particular healthcare event, or eventcategory, computer 110 may limit statistical analysis of healthcarecodes to healthcare events that have been classified as beingpotentially preventable healthcare events of that particular event. Insome particular examples, the Potentially Preventable ReadmissionsClassification System (PPR), available from 3M Company of Saint Paul,Minn. may be used as the basis for determining which healthcare eventsare classified as being potentially preventable healthcare events ofthat particular event.

In summary, computer 110 may update the probability of potentiallypreventable healthcare events (the list of potentially preventablehealthcare events being preclassified as being potentially preventablehealthcare events by PPR or otherwise) for each possible healthcareevent code, such as APR™ DRG code, according to a broad healthcaredatabase, such as an administrative claims database. The updatedprobabilities based on the analysis of the broad healthcare database maythen be stored in a probability matrix for use to evaluate the risks ofall possible potentially preventable healthcare events for a patientbased on the patient's current healthcare event. In this manner, theprobability matrix only includes probabilities of potential futurehealthcare events that are preclassified as being potentiallypreventable. Probabilities of potential future healthcare events thatare not related to a particular healthcare event being analyzed areexcluded from the matrix. For example, while a patient who had coronarybypass surgery may later experience an appendicitis or be injured in acar accident, these potential healthcare events are not potentiallypreventable as they are unrelated to the coronary bypass surgery. Forthis reason, the matrix would not include the probabilities of anappendicitis or car accident injuries with respect to the healthcareevent of coronary bypass surgery. In contrast, the matrix would includethe probability of post-surgical infection as a post-surgical infectionmay be related to coronary bypass surgery, and therefore is consideredpotentially preventable.

In the same or different examples, the probability matrix may furtherincorporate severity factors of potentially preventable healthcareevents. The severity factors may include a clinical severity of thepotentially preventable healthcare event, a financial severity of thepotentially preventable healthcare event and/or other severity metricbeyond the simple probability of the classified potentially preventablehealthcare events. The severity factors may be incorporated into theprobability matrix to create a risk matrix in which includes a riskfactor for all classified preventable healthcare events. In otherexamples, the risk factors in the risk matrix may simply represent theprobabilities of each of the potentially preventable healthcare events.Thus, as referred to herein, the risk factors in the risk matrix mayrepresent any combination of factors in conjunction with a simple riskprobability, including, but not limited to, a financial risk based onthe relative probability of possible readmission outcomes and theircosts, and/or represent clinical severity in order to limit acuteoutcomes, like death.

In this manner, computer 110 may, for each of the plurality ofhealthcare codes, calculates a risk factor for each of the potentiallypreventable healthcare events identified with that healthcare code basedon the administrative claims data. For each of the plurality ofhealthcare codes, computer 110 may then store the risk factor for eachof the potentially preventable healthcare events identified with thathealthcare code in risk database 136 to associate the healthcare codeswith risks of potentially preventable healthcare events.

FIG. 4 is a flowchart illustrating an example technique for evaluatingfuture healthcare event risks of a patient based on the personal healthinformation associated with the patient to facilitate mitigation of therisks of potentially preventable healthcare events for the patient. Thetechniques of FIG. 4 facilitate adjustment of the baseline risks ofpotentially preventable healthcare events stored in risk database 136based on personal health information associated with a patient, toproduce adjusted risks of potentially preventable healthcare events foran individual patient. As referred to herein, the baseline risks ofpotentially preventable healthcare events associated with a patient arebased simply on a singular healthcare event of the patient, and notbased on further patient-specific information. For example, the baselinerisks of potentially preventable healthcare events associated with apatient may be determined solely based on coding of the single healthevent, such as DRG coding and/or APR™ DRGs coding.

While the techniques of FIG. 4 may be used to improve the accuracy ofthe indications of the baseline risks of potentially preventablehealthcare events described with respect to FIG. 3, the techniques ofFIG. 4 may also be utilized to improve the accuracy of risk calculationsof potentially preventable healthcare events determined in any manner.For clarity, the techniques of FIG. 4 are described with respect tocomputer 110 of FIG. 1, although the techniques are equally applicableto a distributed computing system, including the example distributedcomputing system illustrated in FIG. 2.

Computer 110 accesses indications of risks of potentially preventablehealthcare events associated with a patient (402). For example, computer110, including processor 112, may perform the techniques for determiningrisks of potentially preventable healthcare events associated with apatient as described with respect to FIG. 3. In some particularexamples, processor 112 receives an indication of a healthcare event ofa patient, such as an event recorded in patient healthcare data 130 andaccesses indications of risks of potentially preventable healthcareevents associated with the event, e.g., via a probability matrix or riskmatrix within risk database 136.

No matter how processor 112 accesses indications of risks of potentiallypreventable healthcare events associated with a patient, processor 112also accesses personal health information associated with the patient(404). The personal health information associated with the patient maybe located within patient healthcare data 130. The personal healthinformation associated with the patient may be located within patienthealthcare data 130. As one example, the patient's chronic diseaseburden and health status may have a significant effect upon the residualprobability of occurrence of specific types of readmissions. In oneparticular example, the 3M Clinical Risk Groups (CRG) tool, availablefrom 3M Company of Saint Paul, Minn., may be used to define a patient'schronic disease burden and health status.

As one example, the personal health information may include records ofprior healthcare events of the patient, and such records are commonlyavailable as prior claims data. As other examples, the personal healthinformation may include electronic health records for the patient withstructured and/or unstructured data. Computer 110 may analyzeunstructured data using natural language processing techniques in orderto find personal health information relevant to the adjusting thedetermined baseline risks of potentially preventable healthcare eventsassociated with a patient. As one example, computer-based techniques forsearching and identifying key clinical concepts within medical documentsusing natural language processing (NLP) for searching and identify keyclinical concepts within medical documents are disclosed in U.S. Pat.Application No. 61/771,573 filed Mar. 1, 2013, titled IDENTIFICATION OFCLINICAL CONCEPTS FROM MEDICAL RECORDS, the entire contents of which areincorporated by reference herein.

Processor 112 then adjusts the risks of potentially preventablehealthcare events associated with the patient based on the personalhealth information associated with the patient, to produce adjustedrisks of potentially preventable healthcare events (406). Thus, whereasthe baseline risks of potentially preventable healthcare eventsassociated with the patient merely accounted for a singular health eventof the patient, the adjusted risks of potentially preventable healthcareevents incorporate personal health information of the patient into thedetermination of the risks of potentially preventable healthcare eventsassociated with the patient.

In some examples, processor 112 may incorporate additionalpatient-specific information to determine the adjusted risks ofpotentially preventable healthcare events associated with the patient.For example, processor 112 may access demographic information about thepatient. Processor 112 may determine the adjusted risks of potentiallypreventable healthcare events associated with the patient further basedon the demographic information. In some examples, such demographicinformation may include one or more of gender, age, income, ethnicity,housing status, home address, employment status, and marital status.

As another example, computer 110 may request a user provide personalinformation about the patient and receive the requested personalinformation about the patient in response to the request via userinterface 122. As one example, if personal information available toprocessor 112 is incomplete in order to perform an adequatedetermination of the adjusted risks of potentially preventablehealthcare events associated with the patient, processor 112 may requestthe missing information from a user, such as a clinician or the patient.Processor 112 may then determine the adjusted risks of potentiallypreventable healthcare events associated with the patient further basedon the personal information received via the user interface.

Computer 110 presents indications of the adjusted risks of potentiallypreventable healthcare events to a user to facilitate mitigation of therisks of potentially preventable healthcare events for the patient(408). For example, computer 110 may present the relative probabilitiesof each of the potentially preventable healthcare events for the patientto the user. In some examples, presenting indications of the adjustedrisks of potentially preventable healthcare events to the user includesselecting potentially preventable healthcare events with relativelyhigher adjusted risks among a plurality of potentially preventablehealthcare events associated with the healthcare event and thehealthcare codes in the database and presenting indications of theselected potentially preventable healthcare events with relativelyhigher adjusted risks to the user. In this manner, only the potentiallypreventable healthcare events with most severe adjusted risks may bedisplayed for a user, which may highlight these risks and improve theability of the user to implement effective risk mitigation measures.

As described with respect to FIG. 3, computer 110, including processor112, may create or update associations between healthcare events andhealthcare codes within risk database 136 by accessing a database ofhealthcare data for a plurality of patients computer 110 and evaluatingthe probability of potentially preventable healthcare events, the listof potentially preventable healthcare events being preclassified asbeing potentially preventable healthcare events. Similar techniques maybe applied to determine adjustment factors to the baseline risks ofpotentially preventable healthcare events associated with a patientbased on personal patient health information, including prior medicalevent information, demographic information and/or other personalinformation. Alternately or in addition to using statistical analysis todetermine adjustment factors to the baseline risks of potentiallypreventable healthcare events associated with a patient based onpersonal patient information expert consensus, e.g., based on publishedstudies may be used to determine adjustment factors to the baselinerisks of potentially preventable healthcare events associated with apatient based on personal patient information. For example, it is widelyunderstood that homeless patients have much higher readmission rates.However, the housing status of patients may not be generally availablein large volumes of patient records, such as administrative claims data.Accordingly, even though the housing status of patients may have asignificant impact on the actual risks of potentially preventablehealthcare events associated with a patient, there may not be sufficientpatient records to determine appropriate adjustment factors to thebaseline risks using only statistical analysis. In this example, usingexpert consensus may allow for more accurate determinations of risks ofpotentially preventable healthcare events associated with a patient thanallowed by statistical analysis alone. In further examples, acombination of expert consensus and statistical information may be usedto determine adjustment factors based on personal patient information.

FIG. 5 is a flowchart illustrating an example technique for evaluatingfuture healthcare event risks of a patient based on personal informationassociated with the patient to facilitate mitigation of the risks ofpotentially preventable healthcare events for the patient.

The techniques of FIG. 5 facilitate adjustment of the baseline risks ofpotentially preventable healthcare events stored in risk database 136based on personal health information associated with a patient, toproduce adjusted risks of potentially preventable healthcare events foran individual patient. For example, the baseline risks of potentiallypreventable healthcare events associated with a patient may bedetermined solely based on coding of the single health event, such asDRG coding and/or APR™ DRGs coding.

While the techniques of FIG. 5 may be used to improve the accuracy ofthe indications of the baseline risks of potentially preventablehealthcare events described with respect to FIG. 3, the techniques ofFIG. 5 may also be utilized to improve the accuracy of risk calculationsof potentially preventable healthcare events determined in any manner.For clarity, the techniques of FIG. 5 are described with respect tocomputer 110 of FIG. 1, although the techniques are equally applicableto a distributed computing system, including the example distributedcomputing system illustrated in FIG. 2.

The techniques of FIG. 5 incorporate a three stage predictive model witheach subsequent stage refining the prior assessment of the probabilityof specific types of potentially preventable healthcare events so as tobetter account for an individual patient's risks of potentiallypreventable healthcare events. The techniques of FIG. 5 may incorporatea mathematical model that is structurally similar to a three stage leastsquares (3SLS) model that uses a single iteration to compute baselineprobability of a potentially preventable healthcare event beforelayering in additional variables to explain residual variation andimprove the prediction of the probability of a potentially preventablehealthcare event, such as a hospital readmission event. In someexamples, the techniques of FIG. 5 are limited to predicting theprobabilities of potentially preventable hospital readmissions orpredicting the probabilities potentially preventable hospitalreadmissions, ER stays and outpatient observation stays.

The first two stages (steps 502, 504 and 506) utilize routinelycollected administrative data that includes principal and secondarydiagnoses, procedures, procedure dates, age and sex. The third stage(steps 508) utilizes data from an electronic health record or datacollected as an independent adjunct to the administrative data thatincludes socioeconomic status (e.g., living alone), functional status(e.g., ability to ambulate), pharmaceutical usage and detailed clinicaldata such as history and physical and laboratory test results. In stageone, only data from a current medical event of the patient is used. Instages two and three, data from the patient's medical history prior tomedical event is used if available.

In stage one, computer 110 uses administrative claims data to classify apatient based on his or her current medical event, such as a reason forhospital admission, using a mutually exclusive and exhaustive set ofreasons for hospitalization, such as APR™ DRGs (502). In APR™ DRGs theacuity (severity of illness) of the patient is assign based on afour-category scale: minor, moderate, major, or extreme. Eachcombination of a current healthcare event, a potential future healthcareevent and acuity form a unique category.

Based on the identified current healthcare event, all possiblepotentially preventable reasons for healthcare event are identified, forexample, based on PPR. Using large historical databases the rate of(probability of) specific potentially preventable healthcare events hasbeen computed for each unique combination of reason for admission andacuity (referred to as the baseline readmission probability matrix). Instage one, based on a patient's reason for admission and acuity, thebaseline probability of specific types of potentially preventablehealthcare event is determined by looking up the baseline probability inthe baseline healthcare event probability matrix (504). Thus, stage one(steps 502 and 504) is generally similar, and may indeed be the same asthe techniques described with respect to FIG. 3.

In the second stage, computer 110 adjusts the baseline probability ofspecific types of healthcare events by computing the impact ofdemographics and the patient's chronic disease burden and health statusupon the residual probability of occurrence of specific types ofhealthcare events (506). In one particular example, the 3M CRG tool maybe used to define a patient's chronic disease burden and health status.In addition, computer 110 may determine a more accurate assessment of apatient's chronic disease burden and health status if a patient's claimshistory is available for the period preceding the current medical eventbecause computer 110 may determine of the time of onset, frequency andrecency of treatment of disease. When the prior claims history isavailable, computer 110 may incorporate the prior claims history instage two to compute chronic disease burden and health status.

Using large historical databases for each reason for admission, theimpact of demographics and the patient's chronic disease burden andhealth status upon the baseline probability of occurrence of specifictypes of healthcare events has been computed (referred to as thebaseline adjustment factor matrix). In stage two, based on a patient'sreason for admission, demographic, chronic disease burden and healthstatus, computer 110 determines the adjustment factors for specifictypes of potentially preventable healthcare event by looking up theadjustment factors in the baseline adjustment factor matrix. Since priorclaims history data may not always be available, the baseline adjustmentfactor matrix may contain two set of factors based on whether priorclaims history was available for use in determining chronic illnessburden and health status. Thus, stage two (step 506) represents oneexample, of the techniques described with respect to FIG. 4.

Likewise, stage three (step 508) represents a further refinement of thedetermined risks of potentially preventable healthcare events of apatient. For this reason, stage three represents another example of thetechniques described with respect to FIG. 4. In the third stage,computer 110 further adjusts the probability of specific types ofpotentially preventable healthcare events from stage two byincorporating the impact of detailed personal information (508). Suchdetailed personal information may include socioeconomic status (e.g.,living alone), functional status (e.g., ability to ambulate),pharmaceutical usage and detailed clinical data such as history andphysical, laboratory test results, temperature on discharge, andpositive blood cultures. In some examples, computer 110 may obtaindetailed socio-economic and clinical data from an electronic healthrecord (if available) or by direct data entry by hospital staff using astructured data collection instrument that is dynamically tailored tothe patient based on his/her reason for admission. Using largehistorical databases for each reason for admission, the impact ofdetailed socio-economic and clinical data upon the stage two probabilityof occurrence of specific types of healthcare events has been computed(referred in this example as the clinical adjustment factor matrix). Ifthere are socio-economic or clinical data that is not contained in anylarge historical databases but that the published literature has shownhave an impact on the probability of a healthcare event, the publishedliterature may be used as a basis for the clinical adjustment factormatrix. For example, clinical consensus panels may be used to establishthe stage three adjustment factors for these variables. In stage three,based on a patient's detailed socio-economic and clinical data theadjustment factors for specific types of potentially preventablehealthcare event is determined by looking up the adjustment factors inthe clinical adjustment factor matrix.

Computer 110 presents indications of the adjusted risks of potentiallypreventable healthcare events to a user to facilitate mitigation of therisks of potentially preventable healthcare events for the patient viaoutput device 116 (510). For example, computer 110 may present therelative probabilities of each of the potentially preventable healthcareevents for the patient to the user. In some examples, presentingindications of the adjusted risks of potentially preventable healthcareevents to the user includes selecting potentially preventable healthcareevents with relatively higher adjusted risks among a plurality ofpotentially preventable healthcare events associated with the healthcareevent and the healthcare codes in the database. In this manner, only thepotentially preventable healthcare events with most severe adjustedrisks may be displayed for a user, which may highlight these risks andimprove the ability of the user to implement effective risk mitigationmeasures.

The result of this three stage predictive model is a computedprobability that a patient will have a potentially preventablehealthcare event with a specification of the likely reasons for thehealthcare event. For example, the three stage predictive model mayindicate for a single patient: a twenty percent chance of a preventablehealthcare event with fifty percent of those healthcare events being fora post-operative wound infection, thirty percent being for areoccurrence of the original reason for admission, and twenty percentbeing for other reasons. The probability can be used directly orconverted into low to high scale depending on the preference of theuser.

In some particular examples, the techniques of FIG. 5, as well as thetechniques of FIG. 3 and FIG. 4, as described above, may be specificallydirected to determining risks of potentially preventable readmissions.In further more specific examples, such techniques may be applied todetermining risks of potentially preventable hospital readmissions onlyor risks of potentially preventable hospital readmissions, ER stays andoutpatient observation stays. In such specific examples, two differentbaseline risk matrixes may be used: one for determining risks ofpotentially preventable hospital readmissions only and another fordetermining the total risks of potentially preventable hospitalreadmissions, extended ER visits and outpatient observation stays.

Because extended ER visits or observation stays can substitute for ahospital admission, all the probabilities and adjustment factors in thebaseline healthcare event probability matrix, the baseline adjustmentfactor matrix, and the clinical adjustment factor matrix are alsorecomputed with extended ER visits or observation stays treated as ifthey were a hospital admission. By treating an extended ER visit orobservation stay as if it were a hospital admission, the probabilitycomputed by the model represents the probability of a potentiallypreventable hospital readmission or a potentially preventable subsequentER visit or observation stay. In some examples, a provider, such as ahospital, can select which probability it prefers the model to compute.In different examples, both probabilities may be presented to a user.

By utilizing a three stage predictive model that establishes aclinically based (reason for admission and acuity) baseline probabilityof specific types of potentially preventable healthcare event prior toadjusting the probability based on other factors, a greater independenceof the prediction from the specific data used to compute theprobabilities is achieved. This model minimizes the cross correlation ofcomplex clinical factors and non-clinical factors avoiding the varianceinflation observed by other models.

The techniques of this disclosure may be implemented in a wide varietyof computer devices, such as servers (including the Cloud), laptopcomputers, desktop computers, notebook computers, tablet computers,hand-held computers, smart phones, and the like. Any components, modulesor units have been described to emphasize functional aspects and doesnot necessarily require realization by different hardware units. Thetechniques described herein may also be implemented in hardware,software, firmware, or any combination thereof. Any features describedas modules, units or components may be implemented together in anintegrated logic device or separately as discrete but interoperablelogic devices. In some cases, various features may be implemented as anintegrated circuit device, such as an integrated circuit chip orchipset. Additionally, although a number of distinct modules have beendescribed throughout this description, many of which perform uniquefunctions, all the functions of all of the modules may be combined intoa single module, or even split into further additional modules. Themodules described herein are only exemplary and have been described assuch for better ease of understanding.

If implemented in software, the techniques may be realized at least inpart by a computer-readable medium comprising instructions that, whenexecuted in a processor, performs one or more of the methods describedabove. The computer-readable medium may comprise a tangiblecomputer-readable storage medium and may form part of a computer programproduct, which may include packaging materials. The computer-readablestorage medium may comprise random access memory (RAM) such assynchronous dynamic random access memory (SDRAM), read-only memory(ROM), non-volatile random access memory (NVRAM), electrically erasableprogrammable read-only memory (EEPROM), FLASH memory, magnetic oroptical data storage media, and the like. The computer-readable storagemedium may also comprise a non-volatile storage device, such as ahard-disk, magnetic tape, a compact disk (CD), digital versatile disk(DVD), Blu-ray disk, holographic data storage media, or othernon-volatile storage device.

The term “processor,” as used herein may refer to any of the foregoingstructure or any other structure suitable for implementation of thetechniques described herein. In addition, in some aspects, thefunctionality described herein may be provided within dedicated softwaremodules or hardware modules configured for performing the techniques ofthis disclosure. Even if implemented in software, the techniques may usehardware such as a processor to execute the software, and a memory tostore the software. In any such cases, the computers described hereinmay define a specific machine that is capable of executing the specificfunctions described herein. Also, the techniques could be fullyimplemented in one or more circuits or logic elements, which could alsobe considered a processor.

Various examples have been described. For example, while the techniquesdisclosed herein have generally included evaluating future healthcareevent risks of a single patient, the technique may also be applied toevaluating future healthcare event risks of multiple patients, such thatthe relative future healthcare event risks of each patient of a group ofpatients may be compared. For example, by presenting the relative futurehealthcare event risks of each patient of a group of patients within amedical facility, the medical facility may then use such information toallocate resources to mitigate the future healthcare event risks of itspatients most efficiently. In this manner, the techniques disclosedherein may have particular applicability to improving patient caremanagement for a medical facility or other medical care provider. Theseand other examples are within the scope of the following claims.

What is claimed is:
 1. A method of evaluating future healthcare eventrisks of a patient, via one or more computers, the method comprising:receiving, at the one or more computers, patient healthcare data for thepatient, wherein the patient healthcare data represents a healthcareevent and includes one or more healthcare codes; accessing, with the oneor more computers, a database that associates the healthcare event andthe healthcare codes with risks of potentially preventable healthcareevents; and presenting, with the one or more computers, indications ofthe risks of potentially preventable healthcare events to a user tofacilitate mitigation of the risks of potentially preventable healthcareevents for the patient.
 2. The method of claim 1, further comprising:accessing, with the one or more computers, personal health informationassociated with the patient; and adjusting, with the one or morecomputers, the risks of potentially preventable healthcare eventsassociated with the patient, based on the personal health informationassociated with the patient, to produce adjusted risks of potentiallypreventable healthcare events, wherein presenting the indications of therisks of potentially preventable healthcare events to the user includespresenting indications of the adjusted risks of potentially preventablehealthcare events to the user.
 3. The method of claim 2, furthercomprising: accessing, with the one or more computers, demographicinformation about the patient, wherein adjusting, with the one or morecomputers, the risks of potentially preventable healthcare eventsassociated with the patient to produce adjusted risks of potentiallypreventable healthcare events is further based on the demographicinformation.
 4. The method of claim 3, wherein the demographicinformation includes at least one of a group consisting of: gender; age;income; ethnicity; housing status; home address; employment status; andmarital status.
 5. The method of claim 2, further comprising:requesting, with the one or more computers, personal information aboutthe patient; and receiving, with the one or more computers via a userinterface, personal information about the patient in response to therequest, wherein adjusting, with the one or more computers, the risks ofpotentially preventable healthcare events associated with the patient toproduce adjusted risks of potentially preventable healthcare events isfurther based on the personal information received via the userinterface.
 6. The method of claim 1, further comprising: requesting,with the one or more computers, personal information about the patient;receiving, with the one or more computers via a user interface, personalinformation about the patient in response to the request; adjusting,with the one or more computers, the risks of potentially preventablehealthcare events associated with the patient, based on the personalinformation received via the user interface, to produce adjusted risksof potentially preventable healthcare events; and presenting, with theone or more computers, indications of the adjusted risks of potentiallypreventable healthcare events to the user.
 7. The method of claim 1,further comprising: accessing a matrix that identifies potentiallypreventable healthcare events for each of a plurality of healthcarecodes; accessing administrative claims data; for each of the pluralityof healthcare codes, calculating a risk factor for each of thepotentially preventable healthcare events identified with thathealthcare code based on the administrative claims data; and for each ofthe plurality of healthcare codes, storing the risk factor for each ofthe potentially preventable healthcare events identified with thathealthcare code in the database to associate the healthcare codes withrisks of potentially preventable healthcare events.
 8. The method ofclaim 1, wherein the healthcare event includes at least one of a groupconsisting of: an inpatient admission; an emergency room visit; and anoutpatient ancillary service.
 9. The method of claim 1, wherein thepotentially preventable healthcare events are potentially preventablehospital readmissions.
 10. The method of claim 1, wherein presenting,with the one or more computers, indications of the risks of potentiallypreventable healthcare events to the user includes selecting potentiallypreventable healthcare events with relatively higher risks among aplurality of potentially preventable healthcare events associated withthe healthcare event and the healthcare codes in the database andpresenting indications of the selected potentially preventablehealthcare events with relatively higher risks to the user.
 11. Themethod of claim 1, wherein the indications of the risks of potentiallypreventable healthcare events includes an indication, for each of thepotentially preventable healthcare events, of one or more of a groupconsisting of: a probability of the potentially preventable healthcareevent; a clinical severity of the potentially preventable healthcareevent; a financial severity of the potentially preventable healthcareevent; and a compilation of at least two of: the probability of thepotentially preventable healthcare event, the clinical severity of thepotentially preventable healthcare event, and the financial severity ofthe potentially preventable healthcare event.
 12. A computer-readablestorage medium that stores computer-executable instructions that, whenexecuted, configure a processor to: access patient healthcare data for apatient, wherein the patient healthcare data represents a healthcareevent and includes one or more healthcare codes; access a database thatassociates the healthcare event and the healthcare codes with risks ofpotentially preventable healthcare events; and present indications ofthe risks of potentially preventable healthcare events to a user tofacilitate mitigation of the risks of potentially preventable healthcareevents for the patient.
 13. The computer-readable storage medium ofclaim 12, wherein the computer-executable instructions that, whenexecuted, further configure the processor to: access personal healthinformation associated with the patient; and adjust the risks ofpotentially preventable healthcare events associated with the patient,based on the personal health information associated with the patient, toproduce adjusted risks of potentially preventable healthcare events,wherein presenting the indications of the risks of potentiallypreventable healthcare events to the user includes presentingindications of the adjusted risks of potentially preventable healthcareevents to the user.
 14. The computer-readable storage medium of claim13, wherein the computer-executable instructions that, when executed,further configure the processor to: access demographic information aboutthe patient, wherein adjusting the risks of potentially preventablehealthcare events associated with the patient to produce adjusted risksof potentially preventable healthcare events is further based on thedemographic information.
 15. The computer-readable storage medium ofclaim 13, wherein the computer-executable instructions that, whenexecuted, further configure the processor to: request personalinformation about the patient; and receive, via a user interface,personal information about the patient in response to the request,wherein adjusting the risks of potentially preventable healthcare eventsassociated with the patient to produce adjusted risks of potentiallypreventable healthcare events is further based on the personalinformation received via the user interface.
 16. The computer-readablestorage medium of claim 12, wherein the computer-executable instructionsthat, when executed, further configure the processor to: requestpersonal information about the patient; receive, via a user interface,personal information about the patient in response to the request;adjust the risks of potentially preventable healthcare events associatedwith the patient, based on the personal information received via theuser interface, to produce adjusted risks of potentially preventablehealthcare events; and present indications of the adjusted risks ofpotentially preventable healthcare events to the user.
 17. Thecomputer-readable storage medium of claim 12, wherein thecomputer-executable instructions that, when executed, further configurethe processor to: access a matrix that identifies potentiallypreventable healthcare events for each of a plurality of healthcarecodes; access administrative claims data; for each of the plurality ofhealthcare codes, calculate a risk factor for each of the potentiallypreventable healthcare events identified with that healthcare code basedon the administrative claims data; and for each of the plurality ofhealthcare codes, store the risk factor for each of the potentiallypreventable healthcare events identified with that healthcare code inthe database to associate the healthcare codes with risks of potentiallypreventable healthcare events.
 18. The computer-readable storage mediumof claim 12, wherein the healthcare event includes at least one of agroup consisting of: an inpatient admission; an emergency room visit;and an outpatient ancillary service.
 19. The computer-readable storagemedium of claim 12, wherein the potentially preventable healthcareevents are potentially preventable hospital readmissions.
 20. Thecomputer-readable storage medium of claim 12, wherein the indications ofthe risks of potentially preventable healthcare events includes anindication, for each of the potentially preventable healthcare events,of one or more of a group consisting of: a probability of thepotentially preventable healthcare event; a clinical severity of thepotentially preventable healthcare event; a financial severity of thepotentially preventable healthcare event; and a compilation of at leasttwo of: the probability of the potentially preventable healthcare event,the clinical severity of the potentially preventable healthcare event,and the financial severity of the potentially preventable healthcareevent.
 21. A computer system comprising: one or more databases storingpatient healthcare data for a patient and associations betweenhealthcare codes and risks of potentially preventable healthcare events;and one or more processors configured to: access the patient healthcaredata for the patient, wherein the patient healthcare data represents ahealthcare event and includes one or more healthcare codes; accessassociations between the healthcare event and the healthcare codes withrisks of potentially preventable healthcare events; and presentindications of the risks of potentially preventable healthcare events toa user to facilitate mitigation of the risks of potentially preventablehealthcare events for the patient.
 22. The computer system of claim 21,wherein the healthcare event includes at least one of a group consistingof: an inpatient admission; an emergency room visit; and an outpatientancillary service.
 23. The computer system of claim 21, wherein thepotentially preventable healthcare events are potentially preventablehospital readmissions.
 24. The computer system of claim 21, wherein thedatabase stores only the associations between healthcare codes and risksof potentially preventable healthcare events and does not store risks ofpotential healthcare events not associated with a particular healthcarecode.
 25. A method of evaluating future readmission risks of a patient,via one or more computers, the method comprising: receiving, at the oneor more computers, patient healthcare data for the patient, wherein thepatient healthcare data represents a healthcare event associated with ahospital admission and includes one or more healthcare codes; accessing,with the one or more computers, a database that associates thehealthcare codes with risks of potentially preventable readmissionevents; and presenting, with the one or more computers, indications ofthe risks of potentially preventable readmission events to a user tofacilitate mitigation of the risks of potentially preventablereadmission events for the patient.
 26. The method of claim 25, furthercomprising: accessing, with the one or more computers, claims historyand demographic information associated with the patient; and adjusting,with the one or more computers, the risks of potentially preventablereadmission events, based on the claims history and demographicinformation associated with the patient, to produce adjusted risks ofpotentially preventable readmission events, wherein presenting theindications of the risks of potentially preventable readmission eventsto the user includes presenting indications of the adjusted risks ofpotentially preventable readmission events to the user.
 27. The methodof claim 25, further comprising: accessing, with the one or morecomputers, claims history and demographic information associated withthe patient; adjusting, with the one or more computers, the risks ofpotentially preventable readmission events, based on the claims historyand demographic information associated with the patient, to produceadjusted risks of potentially preventable readmission events; accessing,with the one or more computers, personal health information associatedwith the patient; and adjusting, with the one or more computers, theadjusted risks of potentially preventable readmission events associatedwith the patient, based on the personal health information associatedwith the patient, to produce clinically adjusted risks of potentiallypreventable readmission events, wherein presenting the indications ofthe risks of potentially preventable readmission events to the userincludes presenting indications of the clinically adjusted risks ofpotentially preventable readmission events to the user.
 28. The methodof claim 25, wherein the readmission events consist of hospitalreadmission events.
 29. The method of claim 25, wherein the readmissionevents consist of hospital readmission events, emergency room visits andobservation stays.